Healthcare Provider Details

I. General information

NPI: 1558387332
Provider Name (Legal Business Name): SEBASTIAN RODRIGUEZ LEON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HF16 CALLE LIZZIE GRAHAM
TOA BAJA PR
00949-3634
US

IV. Provider business mailing address

PO BOX 195623
SAN JUAN PR
00919-5623
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-2935
  • Fax:
Mailing address:
  • Phone: 787-450-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10974
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: